Provider Demographics
NPI:1184740714
Name:WRIGHT-WATSON, JANNET ELIZABETH (PA)
Entity type:Individual
Prefix:MRS
First Name:JANNET
Middle Name:ELIZABETH
Last Name:WRIGHT-WATSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4 WITMER CT
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-6134
Mailing Address - Country:US
Mailing Address - Phone:631-234-0614
Mailing Address - Fax:718-960-2077
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:SUITE 8C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-960-1400
Practice Address - Fax:718-960-2077
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003623363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant